ELENA DIAZ
Dependent on policy B01M000129
Claims
1
Attributed to this person
Charged
179.00
Total submitted
Denied
179.00
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | ELENA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000129 |
| Date of birth | 9 Nov 1956 |
| Plan | PLATINUM PPO |
| Covered from | 20 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000520 | 21 Jun 2026 | 179.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 179.00 |